title: Pancreato-jejunostomy versus hand-sewn closure of the pancreatic stump to prevent pancreatic fistula after distal pancreatectomy: a retrospective analysis.
abstract: BACKGROUND
  Different methods of pancreatic stump closure after distal pancreatectomy (DP) have been described to decrease the incidence of pancreatic fistula (PF) which still represents one of the most common complications in pancreatic surgery. We retrospectively compared the pancreato-jejunostomy technique with the hand-sewn closure of the pancreatic stump after DP, and analyzed clinical outcomes between the two groups, focusing on PF rate.
  
  
  METHODS
  Thirty-six patients undergoing open DP at our institution between May 2005 and December 2011 were included. They were divided in two groups depending on pancreatic remnant management: in 24 cases the stump was closed by hand-sewn suture (Group A), while in 12 earlier cases a pancreato-jejunostomy was performed (Group B). We analyzed postoperative data in terms of mortality, morbidity and length of hospital stay between the two groups.
  
  
  RESULTS
  PF occurred in 7 of 24 (29.1%) cases of group A (control group) compared to zero fistula rate in group B (anastomosis group) (p=0.005). Operative time was significantly higher in the anastomosis group (p=0.024). Mortality rate was 0% in both groups. Other postoperative outcomes such as hemorrhages, infections, medical complications and length of hospital stay were not significant between the two groups.
  
  
  CONCLUSIONS
  Despite a higher operative time, the pancreato-jejunostomy after DP seems to be related to a lower incidence of PF compared to the hand-sewn closure of the pancreatic remnant.
authors.affiliation: Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy. robmeni@tiscali.it
authors.forename: Roberto L
authors.initials: RL
authors.lastname: Meniconi
authors.forename: Roberto
authors.initials: R
authors.lastname: Caronna
authors.forename: Dario
authors.initials: D
authors.lastname: Borreca
authors.forename: Monica
authors.initials: M
authors.lastname: Schiratti
authors.forename: Piero
authors.initials: P
authors.lastname: Chirletti
mesh_terms: D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D005260:Female; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications; D013536:Suture Techniques